Date of Award

9-19-2025

Degree Type

Thesis

Degree Name

Master of Health Professions Education (MPHE)

First Advisor

Dr Qamar Riaz

Second Advisor

Dr Rahila Ali

Third Advisor

Professor Raheela Yasmin

Department

Educational Development

Abstract

Introduction: Residency programs bridge the gap between a medical school graduate and a fully trained professional and hence are crucial for professional development. Post graduate education requires significant investment from an institution to recruit, train and supervise residents. Attrition negatively impacts successful running of a residency program by causing a loss of time, resources, and morale, for both the trainees and the training program. A deeper understanding into the reasons behind attrition, as well as formulating mechanisms to reduce it would confer benefit to all stakeholders involved in post graduate medical education. The lack of robust, context-specific evidence limits the ability to design effective strategies for resident retention, support, and wellness. Our study was the first to be conducted at institutional level nationally and we aimed to address existing gaps in literature as well as recommending feasible solutions.
Methods: We conducted an explanatory, sequential mixed-methods (QUAN-qual) design study over a 6 month period to comprehensively understand the issue of resident attrition in a university teaching hospital. Quantitative data was collected on a predesigned form from PGME office, HR department, program office and program directors, and CPSP for eligible residency programs. This was analyzed to get the program specific incidence of attrition over three consecutive years. Residency programs to be included in the qualitative phase were identified from the quantitative phase. Interviews were conducted with residents, faculty, and PD / APD of included programs on a pre-defined interview guide in number sufficient to achieve data saturation focusing on reasons for and solutions to address attrition.
Results: Out of 34 residency programs, 18 qualified to be included in quantitative phase. Only one program had an attrition rate of more than 10% for all three years of study. For enrichment of data, we included participants from programs having attrition of more than 10% in any year of study. Total of 11 interviews were conducted involving all four groups. The major rectifiable issues attributing to attrition that we identified at our institute were the lack of support for residents during pregnancy and child-care, the academic environment, mainly the working hours and supervision level, and the fact that training programs abroad were considered better opportunities. In addition to solutions corresponding to reasons for attrition, having gender balance in the programs and introducing program specific induction criteria were suggested.
Conclusion: This is the first study conducted at institutional level with robust methodology. A major gap in literature regarding the primary definition of attrition has been identified. This study highlights several important reasons for attrition and suggestions for reducing its incidence. Further studies are required to validate our results as well as to gather more data across the country to account for demographic bias as well as to provide reasonable incentive to the governing CPSP to work closely with programs throughout the country and introduce measures for reducing attrition

First Page

1

Last Page

93

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